Abstract Pressure ulcers are a significant healthcare problem for the growing number of older long-term care (LTC) residents in the United States and around the world. Pressure ulcers diminish quality of life, exact a devastating loss of function, increase the risk of death in geriatric populations and raise healthcare costs. Costs for the management of pressure ulcers in the US likely exceeds $6.4 billion annually, with a prevalence of approximately 12% in the high risk LTC population. At Pitt, we have been studying the effects of seat cushions on pressure ulcer incidence and have found that when a skin protection seat cushion is used with a properly fitted wheelchair there is a significant reduction in incidence. Our data has now led us to question whether having a properly fitted wheelchair also has a significant effect on pressure ulcer incidence. To investigate this question, we are proposing a new study, RCT Wheelchair 2 (RCT-WC2), in which subjects will be randomized into a control group that receives a skin protection cushion and wheelchair training for use in their facility supplied wheelchair, or a treatment group that receives a skin protection cushion, wheelchair training and a new custom-fitted wheelchair. We expect that the treatment group will have a lower incidence of pressure ulcers. PUBLIC HEALTH RELEVANCE: The proposed clinical trial is aimed at demonstrating the important role wheelchairs play in preventing pressure ulcers (bed sores). Although most pressure ulcers can be prevented, they are common in nursing home settings because their causes are difficult to identify. The proposed trial, if successful, will guide practitioners toward improving preventive care practices by demonstrating how to effectively apply wheelchair and seat cushion technology